PL CLAIM SPECIALIST

Sedgwick • St Thomas, VI • 3w ago

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

PL CLAIM SPECIALIST

PRIMARY PURPOSE : To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.

Negotiates claim settlement up to designated authority level.

Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.

Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.

Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.

Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.

Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.

Represents Company in depositions, mediations, and trial monitoring as needed.

Communicates claim activity and processing with the client; maintains professional client relationships.

Ensures claim files are properly documented and claims coding is correct.

Refers cases as appropriate to supervisor and management.

Delegates work and mentors assigned staff.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.

Experience

Six (6) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business

Excellent oral and written communication, including presentation skills

PC literate, including Microsoft Office products

Analytical and interpretive skills

Strong organizational skills

Excellent negotiation skills

Good interpersonal skills

Ability to work in a team environment

Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical : Computer keyboarding, travel as required

Auditory/Visual : Hearing, vision and talking

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $117,000 - $125,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com

Similar Jobs

Digital Marketing Manager

Rubrik • St Thomas, VI • 3h ago

Management & Administrative

Digital Marketing Manager Rubrik is hiring for a highly motivated, data-driven digital marketer that will help drive our full-funnel paid media efforts. The Digital Marketing Manager will play a key role in the developme...

3h ago

Go to Apply

Backend Software Engineer

Eliassen Group • St Thomas, VI • 11h ago

IT & Engineering

Backend Software Engineer Anywhere Type: Contract Category: Development Industry: Technology Workplace Type: Remote Reference ID: JN -022026-105343 Date Posted: 02/03/2026 Shortcut: http://careers.eliassen.com/2NCQux Des...

11h ago

Go to Apply

Director of Product Management - Clinical Note AI Agent

Oracle • St Thomas, VI • 22h ago

Hospital & Medical

Job Description The Clinical Note AI Agent Product Management Leader will be responsible for defining and executing the global strategy for our rapidly expanding product - Clinical Note AI Agent. This role will drive pro...

22h ago

Go to Apply

NetSuite - Sales Manager - Austin, TX

Oracle • St Thomas, VI • 23h ago

Management & Administrative

Job Description About Oracle NetSuite Do you want to advance your career with the world's first cloud company? Since 1998, Oracle NetSuite has been on a mission to deliver an agile, unified application suite that gives l...

23h ago

Go to Apply

Senior Product Operations Manager

General Motors • St Thomas, VI • 1d ago

Management & Administrative

Job Description At General Motors, our product teams are redefining mobility. Through a human-centered design process, we create vehicles and experiences that are designed not just to be seen, but to be felt. We're turni...

1d ago

Go to Apply

Director, Software Engineering

Oracle • St Thomas, VI • 1d ago

IT & Engineering

Job Description OCI's Identity and Access Management organization offers exciting opportunities for you! Our engineering team is looking for a Software Development Director to help us enhance and build new capabilities i...

1d ago

Go to Apply

Customer Service Associate I

Intermountain Health • St Thomas, VI • 1d ago

Management & Administrative

Job Description: A Customer Service Associate I is responsible for handling inbound and outbound calls to assist patients with billing inquiries, complaints, and requests. The caregiver utilizes overall knowledge of the...

1d ago

Go to Apply

Industrial Sales Coordinator (Central Time)

WM • St Thomas, VI • 1d ago

Legal & Paralegal

I. Job Summary Sets up and maintains digital customer records and provides administrative support for the Technical Service Center and Manufacturing & Industrial Sales Team. This team handles all billing for our Oil...

1d ago

Go to Apply

Advisor, Finance Operations (Pharma Customer Rebates)

Cardinal Health • St Thomas, VI • 1d ago

Finance, Accounting & Banking

What Finance Operations contributes to Cardinal Health Finance oversees the accounting, tax, financial plans and policies of the organization, establishes and maintains fiscal controls, prepares and interprets financial...

1d ago

Go to Apply

Field Marketing Manager

Oracle • St Thomas, VI • 2d ago

Management & Administrative

Job Description 8+ years experience in B2B demand generation marketing or event management Proven ability to design demand generation plans and industry-specific campaigns Demonstrated experience managing complex workflo...

2d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.